Factors Influencing the Blending of the Nurse-patient Relationship

According to Peplau (1952/1988), nursing is therapeutic because it is a healing art, assisting an individual who is sick or in need of health care. Nursing can be viewed as an interpersonal process because it involves interaction between two or more individuals with a common goal. In nursing, this common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing as a result of the interaction. An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli.

Major Concepts

Peplau (1952/1988) defines man as an organism that “strives in its own way to reduce tension generated by needs.” The client is an individual with a felt need

Health is defined as “a word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.”

Although Peplau does not directly address society/environment, she does encourage the nurse to consider the patient’s culture and mores when the patient adjusts to hospital routine.

Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal process.” She defines it as a “human relationship between an individual who is sick, or in need of health services, and a nurse specially educated to recognize and to respond to the need for help.”

Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse that focuses on the client’s needs, feelings, problems, and ideas.

Nursing involves interaction between two or more individuals with a common goal. The attainment of this goal, or any goal, is achieved through a series of steps following a sequential pattern.

Four Phases of the therapeutic nurse-patient relationship:

1. The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions.

2. The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.

3. In the exploitation phase, the client makes full use of the services offered.

4. In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends.

Anxiety was defined as the initial response to a psychic threat.

Subconcepts

Roles of the Nurse in the Therapeutic relationship

The primary roles she identified are as follows:

Stranger: offering the client the same acceptance and courtesy that the nurse would to any stranger

Surrogate: serving as a substitute for another such as a parent or a sibling

Counselor: promoting experiences leading to health for the client such as expression of feelings

Peplau also believed that the nurse could take on many other roles, including consultant, tutor, safety agent, mediator, administrator, observer, and researcher. These were not defined in detail but were “left to the intelligence and imagination of the readers.” (Peplau, 1952)

Four Levels of Anxiety

1. Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. The person can take in all available stimuli (perceptual field).

2. Moderate anxiety involves a decreased perceptual field (focus on immediate task only); the person can learn new behavior or solve problems only with assistance. Another person can redirect the person to the task.

3. Severe anxiety involves feelings of dread and terror. The person cannot be redirected to a task; he or she focuses only on scattered details and has physiologic symptoms of tachycardia, diaphoresis, and chest pain.

4. Panic anxiety can involve loss of rational thought, delusions, hallucinations, and complete physical immobility and muteness. The person may bolt and run aimlessly, often exposing himself or herself to injury.

Assumptions

Nurse and patient can interact.

Peplau stresses that both the patient and nurse mature as the result of the therapeutic interaction.

Peplau believed that nurses must clearly understand themselves to promote their client’s growth and to avoid limiting client’s choices to those that nurses value.

Strengths/Weaknesses

Strengths:

The phases provide simplicity regarding the natural progression of the nurse-patient relationship.

This simplicity leads to adaptability in any nurse-patient interaction, thus providing generalizability.

Weaknesses:

Health promotion and maintenance were less emphasized.

The theory cannot be used in a patient who doesn’t have a felt need such as with withdrawn patients.

Analysis

Peplau conceptualized clear sets of nurse’s roles that can be used by each and every nurse with their practice. It implies that a nurse’s duty is not just to care but the profession encompasses every activity that may affect the care of the patient.

The idea of a nurse-client interaction is limited with those individuals incapable of conversing, specifically those who are unconscious.

The concepts are highly applicable with the care of psychiatric patients considering Peplau’s background. But it is not limited in those set of individuals. It can be applied to any person capable and has the will to communicate.

The phases of the therapeutic nurse-client are highly comparable to the nursing process making it vastly applicable. Assessment coincides with the orientation phase; nursing diagnosis and planning with the identification phase; implementation as to the exploitation phase; and lastly, evaluation with the resolution phase.